Clinicians in 25 countries prefer to use lower levels of oxygen to resuscitate preterm infants at birth

Ju Lee Oei; Alpana Ghadge; Elisabeth Coates; Ian M Wright; Ola D Saugstad; Maximo Vento; Giuseppe Buonocore; Tatsuo Nagashima; Keiji Suzuki; Shiguhero Hosono; Peter G Davis; Paul Craven; Lisa Askie; Jennifer Dawson; Shalabh Garg; Anthony Keech; Yacov Rabi; John Smyth; Sunil Sinha; Ben Stenson; Kei Lui; Carol Lu Hunter; William Tarnow Mordi; HOLISTIC (Higher Or Lower oxygen and Infant Saturation Targeting: International Collaboration) Study Group

doi:10.1111/apa.13485

Clinicians in 25 countries prefer to use lower levels of oxygen to resuscitate preterm infants at birth

Acta Paediatr. 2016 Sep;105(9):1061-6. doi: 10.1111/apa.13485. Epub 2016 Jun 24.

Authors

Ju Lee Oei^{1

2

3}, Alpana Ghadge³, Elisabeth Coates³, Ian M Wright^{4

5}, Ola D Saugstad⁶, Maximo Vento⁷, Giuseppe Buonocore⁸, Tatsuo Nagashima⁹, Keiji Suzuki¹⁰, Shiguhero Hosono¹¹, Peter G Davis^{12

13}, Paul Craven⁵, Lisa Askie³, Jennifer Dawson^{12

13}, Shalabh Garg¹⁴, Anthony Keech³, Yacov Rabi¹⁵, John Smyth^{1

2}, Sunil Sinha¹⁴, Ben Stenson¹⁶, Kei Lui^{1

2}, Carol Lu Hunter², William Tarnow Mordi³; HOLISTIC (Higher Or Lower oxygen and Infant Saturation Targeting: International Collaboration) Study Group

Affiliations

¹ School of Women's and Children's Health, The University of New South Wales, Kensington, NSW, Australia.
² Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia.
³ NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.
⁴ Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, Australia.
⁵ Department of Neonatology, The John Hunter Hospital, Newcastle, NSW, Australia.
⁶ Department of Pediatric Research, Oslo University Hospital, The University of Oslo, Oslo, Norway.
⁷ Department of Pediatrics, University of Valencia, Valencia, Spain.
⁸ Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
⁹ National Home Doctor Service, Spring Hill, QLD, Australia.
¹⁰ Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
¹¹ School of Medicine, Nihon University, Tokyo, Japan.
¹² The Royal Women's Hospital, Melbourne, VIC, Australia.
¹³ Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
¹⁴ South Tees Hospitals, Middlesborough, UK.
¹⁵ Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
¹⁶ Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK.

PMID: 27228325
DOI: 10.1111/apa.13485

Abstract

Aim: This study determined current international clinical practice and opinions regarding initial fractional inspired oxygen (FiO2 ) and pulse oximetry (SpO2 ) targets for delivery room resuscitation of preterm infants of less than 29 weeks of gestation.

Methods: An online survey was disseminated to neonatal clinicians via established professional clinical networks using a web-based survey programme between March 9 and June 30, 2015.

Results: Of the 630 responses from 25 countries, 60% were from neonatologists. The majority (77%) would target SpO2 between the 10th to 50th percentiles values for full-term infants. The median starting FiO2 was 0.3, with Japan using the highest (0.4) and the UK using the lowest (0.21). New Zealand targeted the highest SpO2 percentiles (median 50%). Most respondents agreed or did not disagree that a trial was required that compared the higher FiO2 of 0.6 (83%), targeting the 50th SpO2 percentile (60%), and the lower FiO2 of 0.21 (80%), targeting the 10th SpO2 percentile (78%). Most (65%) would join this trial. Many considered that evidence was lacking and further research was needed.

Conclusion: Clinicians currently favour lower SpO2 targets for preterm resuscitation, despite acknowledging the lack of evidence for benefit or harm, and 65% would join a clinical trial.

Keywords: Oxygen; Preterm babies; Resuscitation; Survey.

Publication types

Multicenter Study

MeSH terms

Asphyxia Neonatorum / therapy*
Humans
Infant, Newborn
Infant, Premature
Neonatologists / statistics & numerical data*
Oxygen / administration & dosage*
Resuscitation*
Surveys and Questionnaires

Substances

Oxygen